RMHP Monument Health Silver Advantage-E ($0 Virtual UC, $7 Tier 2 Rx, $0 Insulin, No Referrals, Rx Copay)
Rocky Mountain Health Maintenance Organization, Inc. · 2027 plan year
Silver
- Ind. deductible
- $4,500
- Family deductible
- $9,000
- Ind. OOP max
- $9,500
- Family OOP max
- $19,000
Other cost-sharing reduction variants for this plan:
More Rocky Mountain Health Maintenance Organization, Inc. plans in CO
RMHP Monument Health Gold Value ($0 Virtual UC, $5 Tier 2 Rx, $0 Insulin, No Referrals, Rx Copay)RMHP Monument Health Silver Value ($0 Virtual UC, $0 Insulin, No Referrals, Rx Copay)RMHP Monument Health Bronze Value ($0 Virtual UC, HSA, $0 Insulin, No Referrals, Rx Copay)RMHP Monument Health Bronze Value HSA ($0 Virtual UC, $0 Insulin, No Referrals)
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $3.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $50.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 30.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $1000.00 Copay per Day |
| Outpatient Surgery Physician/Surgical Services | 30.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $20.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $7.00 |
| Medical Service Drugs | 30.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs | $350.00 |
| Non-Preferred Generic Drugs | $50.00 |
| Preferred Brand Drugs | $50.00 |
| Preventive Drugs | No charge |
| Specialty Drugs | $550.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Intensive Outpatient for Mental/Behavioral Health | 30.00% Coinsurance after deductible |
| Intensive Outpatient for Substance Use Disorder | 30.00% Coinsurance after deductible |
| Mental Health Wellness Visit | No charge |
| Mental/Behavioral Health Inpatient Services | $1000.00 Copay per Day |
| Mental/Behavioral Health Outpatient Services | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Prenatal Care | $30.00 |
| Office Visit - Mental/Behavioral Health | $30.00 |
| Office Visit - Substance Use Disorder | $30.00 |
| Partial Hospitalization for Mental/Behavioral Health | 30.00% Coinsurance after deductible |
| Partial Hospitalization for Substance Use Disorder | 30.00% Coinsurance after deductible |
| Postpartum Mental/Behavioral Health | $30.00 |
| Postpartum Substance Use Disorder | $30.00 |
| Residential Day Treatment for Mental/Behavioral Health | 30.00% Coinsurance after deductible |
| Residential Day Treatment for Substance Use Disorder | 30.00% Coinsurance after deductible |
| Substance Use Disorder Prenatal Care | $30.00 |
| Telehealth Mental/Behavioral Health | $30.00 |
| Telehealth Substance Use Disorder | $30.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | No charge |
| Acupuncture | $3.00 |
| Allergy Testing | 30.00% Coinsurance after deductible |
| Applied Behavior Analysis Based Therapies | 30.00% Coinsurance after deductible |
| Autism Spectrum Disorders - Assessment and Evaluation Services | $50.00 |
| Bariatric Surgery | 30.00% Coinsurance after deductible |
| Basic Dental Care - Child | No charge |
| Chemotherapy | 30.00% Coinsurance after deductible |
| Chiropractic Care | $3.00 |
| Delivery and All Inpatient Services for Maternity Care | $1,000.00 |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $50.00 |
| Diabetic Supplies | 30.00% Coinsurance after deductible |
| Dialysis | 30.00% Coinsurance after deductible |
| Durable Medical Equipment | 30.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 30.00% Coinsurance after deductible |
| Eye Glasses for Children | 30.00% Coinsurance after deductible |
| Gender Affirming Care | 30.00% Coinsurance after deductible |
| Habilitation Services | $50.00 |
| Hearing Aids | 30.00% Coinsurance after deductible |
| Home Health Care Services | 30.00% Coinsurance after deductible |
| Hospice Services | 30.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 30.00% Coinsurance after deductible |
| Infertility Treatment | 30.00% Coinsurance after deductible |
| Infusion Therapy | 30.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | No charge |
| Inpatient Rehabilitation | $1,000.00 |
| Laboratory Outpatient and Professional Services | $25.00 |
| Major Dental Care - Child | No charge |
| Nutritional Counseling | 30.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $3.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 30.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $50.00 |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | 30.00% Coinsurance after deductible |
| Prosthetic Devices | 30.00% Coinsurance after deductible |
| Prosthetics: Legs and Arms | 20.00% |
| Prosthetics: Recreational | 30.00% Coinsurance after deductible |
| Radiation | 30.00% Coinsurance after deductible |
| Reconstructive Surgery | 30.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $50.00 |
| Rehabilitative Occupational Therapy | $50.00 |
| Rehabilitative Physical Therapy | $50.00 |
| Rehabilitative Speech Therapy | $50.00 |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | $1000.00 Copay per Day |
| Standalone Laboratory | $25.00 |
| Substance Abuse Disorder Inpatient Services | $1000.00 Copay per Day |
| Substance Abuse Disorder Outpatient Services | 30.00% Coinsurance after deductible |
| Telehealth PCP | $3.00 |
| Telehealth Specialist | $50.00 |
| Transplant | $1,000.00 |
| Treatment for Temporomandibular Joint Disorders | 30.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 30.00% Coinsurance after deductible |
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